2016 Box Hill Institute Group Scholarships – Application Form

SECTION 1 - To be completed by Learner/School Delegate/Nominator (please also complete Section 3)

Eligibility / Application Closing Date / Tick
Financial Hardship Scholarship / These scholarships are available to students experiencing financial hardship and are studying a course that comes under one of the relevant Industry Skills Councils. / Friday 1st April 2016
Academic Excellence / These scholarships are available to students who showacademic excellence.
Global Experience / These scholarships are available to students who have been selectedfor Study Aboard programs.

Learners Details:

First Name: / Surname:
Date of Birth: / Male / Female
Address: / Suburb: / Post Code:
Email:
Phone: / Mobile:
Date of application:
Course Name:
Currently enrolled: / Yes / No / Student ID (if known):
Name of School Delegate/Nominator:
School:
Email:
Phone:
Date:

Category of Scholarship (please tick):

Financial Hardship / Academic Excellence
(School Learner/Apprentice of the Year ) / Global Experience
Nominator Support for Nominee Application(dot points only)

SECTION 2 - To be completed by Learner (please also complete Section 3)

Please provide a TYPED statement below as to how this scholarship will assist you with your academic achievements.
This should include information on your background, your aspirations, long-term goals, your intentions after graduating from Box Hill Institute and what receiving this scholarship will mean to you. Please include second page if needed.

LEARNERS PLEDGE:

In accepting a scholarship, I agree to:

  • Maintain satisfactory progress in my chosen studies;
  • Complete the study in which I am current enrolled;
  • Act as a positive ambassador for Box Hill Institute;
  • Attend the Annual Sponsors Recognition Function;
  • Be available for media interviews and photo sessions and provide permission for subsequent promotion regarding my achievement;
  • Allow my contact details to be given to scholarship donor on request as part of application process.

I understand that if I fail to fulfil the Learners Pledge above, I will be required to repay BHI up to the value of the scholarship.

Learners Name: / Signature: / Date:

Please ensure ALL documents listed below (relevant to the scholarship category selected in Section1)

are attached to your application form.

Financial Hardship / Academic Excellence / Global Experience
Photo Copy of Health Care Card / / Photo Copy of Health Care Card / / Copy of Statement of Results /
Photo Copy of Course Placement letter / / Photo Copy of Course Placementletter / / Current Resume (must include names, contact numbers and email addresses of two referees) /

Photo Copy of Enrolment Form / / Photo Copy of Enrolment Form /
Current Resume(must include names, contact numbers and email addresses of two referees) / / Current Resume (must include names, contact numbers and email addresses of two referees) / / Proof of Australian citizenship (Green Medicare card, Australian Passport or Australian Birth Certificate)
Proof of Australian citizenship(Green Medicare card, Australian Passport or Australian Birth Certificate) /

SECTION 3 -To be completed by School Delegate & Learner

School Delegate:
I declare that I have sighted originals of all supporting documentation provided by the Learner.
Signed: / Date:
Learner/Nominee:
I confirm that all documents and information submitted related to this scholarship are true and correct. I declare that the information contained in this application and supporting documentation is true and correct. I have read and understood the Learners Pledge regarding acceptance of this scholarship and promotional requirements by Box Hill Institute. I understand that I can only receive one scholarship from Box Hill Institute per calendar year.
Learners Name: / Signature: / Date:
Please return your completed application to:

OR
Student Mobility and Scholarship Coordinator
Building 4, Elgar Campus
465 Elgar Road
Box Hill VIC 3128
Phone enquiries: 9286 9601
Office use only:
Received
Processed
Nominator Notified
Nominator Notified
Processing Officer:
Application Outcome :
Category of Scholarship
Industry Skills Council (please tick): / Tick
Community Services and Health ISC
EE-Oz Training Standards
Innovation and Business Skills
Manufacturing Skills Australia
Service Skills Australia
Construction & Property Services
Transport & Logistics
Page 1 of 3 / Box Hill Quality SystemBHIG Scholarships Application FormV2.2016